///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME DIAGNOSED IN A PERIPARTURIENT FOLLOWING EPIDURAL BLOOD PATCH FOR THE TREATMENT OF HEADACHE

Abstract Number: 59
Abstract Type: Case Report/Case Series

Lindsay Cobb M.D.1 ; Girish Mulgaokar M.D.2

A postpartum headache may be the result of numerous etiologies including those related to pregnancy and others that are not. There are many non-vascular, intracranial disorders that may result in headache including dural puncture or seizure. We report a healthy patient with a postpartum headache that initially presented as a post-dural puncture headache, but was later diagnosed as posterior reversible encephalopathy syndrome (PRES). The syndrome has been associated with preeclampsia, eclampsia, and other hypertensive syndromes. This may be a first report of PRES in a healthy female presenting with a sole complaint of headache. A 23-year-old laboring prima-gravida underwent an urgent cesarean section under epidural anesthesia in the 39th week of gestation for chorioamnionitis with first stage arrest of labor. On post-operative day seven she presented with an unrelenting headache. The headache was described as worse with sitting, standing, and walking. The headache improved when she was recumbent. A working diagnosis of a post-dural puncture headache was made. An epidural blood patch was performed. After close observation, the blood patch did not relieve the patients headache and she was admitted for observation and a further work-up. The neurology service was consulted. The following morning, the patient was disoriented and confused. A head CT showed diffuse cerebral edema. The patient was admitted to the neurology service. Thereafter, she developed a progressive leukocytosis, generalized tonic-clonic seizure, and a non-orthostatic headache. An MRI of the head showed lesions in the subcortical white matter of the parietal lobe, having the appearance of PRES. After one week, the patient was discharged to home on systemic corticosteroids and an anticonvulsant with complete resolution of her headache. We describe a unique case of PRES in a previously healthy parturient who presented atypically with normotension, without an initial seizure, and symptoms consistent with a post-dural puncture headache. This case highlights the importance of including all causes of headache in the differential diagnosis for a parturient with a headache following an epidural anesthetic. Close evaluation by the anesthesia team helped to ensure this patients clinical improvement. When epidural blood patch failed to relieve her symptoms, admission to the hospital and continued reassessment by the neurological service led to the appropriate diagnosis.



SOAP 2009